-
Cyclophosphamide (nitr must alk agent)
- Take with food
- Not a vesicant
-
Mechlorethamine (nitr must alk agent)
= Vesicant
-
Bendamustine (nitr must alk agent)
Infusion rxn
-
Estramustine (nitr must alk agent)
- THROMBOSIS
- Gyneocomastia
- Breast tenderness
- Edema
- Admin: 1H before or 2H after meal
- Avoid taking w/ milk or other ca-rich foods or drugs => affects absorption
-
Chlorambucil (nitr must alk agent)
- Pulmonary infiltrates/fibrosis
- Hepatotoxicity
-
Nitrosureas, generally...
Cross the BBB!
-
Carmustine (nitros alk agent)
- Nadir: 4-6 wks after treatment - do CBC here!
- Injury: kidney, liver, lungs
-
Lomustine (nitros alk agent)
- Delayed BM suppression
- Potential for pulmonary fibrosis
- Renal/hepatic toxicity
-
Streptozocin (nitros alk agent)
- Unique MoA: glucose moiety => for metastatic islet cell tumors
- Hypo/Hyperglycemia
- Minimal BM suppression
- D-L tox = kidney damage
-
Busulfan (other alk agent)
PULMONARY TOXICITY
-
Temozolomide (other alk agent)
- Empty stomach
- Don't crush, open, chew, inhale!
-
Cisplatin (plat comp)
- Kidney damage: => extensive hydration + diuretic therap + amifostine
- Ototoxicity
-
Carboplatin (plat comp)
Not special. :(
-
Oxaliplatin (plat comp)
Peripheral sensory neuropathy: avoid cold stuff
-
Methotrexate (FA analog antimetab)
- Inhibs dihydrofolate reductase: (the enz that converts dihydrofolic acid => tetrahydrofolic acid) - req for activation folic acid => suppress biosynthesis of thymidylate => unable to make DNA => cell kill!
- BM suppression
- Oral & GI ulceration (can => DEATH)
- Pulmonary infiltrates & fibrosis
- **GIVE leucovorin!!!: rescue marrow and GI mucosa cells
-
Pemetrexed (FA analog antimetab)
Give folic acid and B12 prophylaxis: to decr BM and GI tox
-
Cytarabine (Pyrim analog antimetab)
- Liposomal form: arachnoiditis
- Pulmonary edema
- Central & peripheral neurotox
-
Fluorouracil, 5-FU (Pyrim analog antimetab)
Hand & Foot Syndrome
-
Capecitabine (Pyrim analog antimetab)
HFS
-
Mercaptopurine (Pur analog antimetab)
- Hepatic metab catalyzed by xanthine oxidase: if pt has gout, CANNOT give allopurino or febuxostat (xanth ox inhibs)
- Heptatic dysfunction: jaundice
-
Thioguanine (Pur analog antimetab)
- Similar activity to mercaptopurine
- Can give w/ allopurinol or febuxostat!
-
Pentostatin (Pur analog antimetab)
DON'T prescribe w/ fludarabine! => pulmonary toxicity!
-
Fludarabine (Pur analog antimetab)
- DON'T prescribe w/ pentostatin! => pulnoary toxicity!
- Autoimmune hemolytic anemia
- Severe neurologic fx
-
Cladribine (Pur analog antimetab)
Acute and delayed-onset nephrotoxicity!! (w/ high dose)
-
Anthracyclines (lumped 2geth. Antitumor antibios)
- Potential for cardiotoxicity
- VESICANTS
- Red sweat urine, except mitoxantrone (blue-green)
- **Dexrazoxane**: helps prevent extravasation; also admin IV to prevent doxorubicin-assoc cardiomyopathy in pts treated for breast cancer
-
Epirubicin (anthr antitum antibio)
Irreversible amenorrhea & premature menopause
-
Bleomycin (non-anthra antitum antibio)
- LUNG injury: pneumonitis => severe pulm fibrosis and death
- Do pulmonary func test @ baseline & after
- VERY little BM suppression
-
Mitomycin (non-anthra antitum antibio)
- Delayed BM suppress (3-4 wks)
- Irreversible renal failure
- VESICANT
-
Vincristine (vinca alk mit inhib)
- BM sparing!
- Peripheral neuropathy
- VESICANT
-
Vinblastine (vinca alk mit inhib)
-
Vinorelbine (vinca alk mit inhib)
- Interstitial pulm changes
- Adult resp distress syndrome
- 50% of pts get neutropenia
-
Paclitaxel (taxoid mit inhib)
- 1 w/ solvent, 1 w/o: pt can react to one w/ => give glucocorticoid + antihistamine
- Cardiotox: brady, 2nd/3rd deg HB, FATAL MI
-
Docetaxel (taxoid mit inhib)
- Hypersens/infus rxn: pretreat w/ antihist & glucocort
- Signif neutropenia: withold if <1500
- Liver disease? ==> incr risk SEPSIS & FLUID RETENTION (use glucocorticoids)
-
Topotecan (top I inhib)
Withold if neutrophils <1500
-
Irinotecan (top I inhib)
- DIARRHEA: depends; fluid replace,
- **Early: ATROPINE
- **Late: LOPERAMIDE
- Withold if neutrophils <500
-
Etoposide (top II inhib)
Infusion rxn: hypoTN w/ rapid infusion
-
Teniposide (top II inhib)
SEVERE hypersens rxn!!: suppress w/ epinephrine
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